In 2001 the National Cholesterol Education Program Expert Panel released the third report on the detection, evaluation, and treatment of high blood cholesterol (ATP III) in adults. Currently in the United States, an estimated 65 million people have high cholesterol levels, and nearly 37 million (one in five adults) are eligible for cholesterol lowering therapy. A strong link exists between cardiovascular disease, which is the leading cause of death in the United States, and high cholesterol levels. Not only is having high cholesterol harmful to the body, it is fatal because risk of death is progressive with increasing total cholesterol values. This third report provides updated guidelines for testing, treatment to reduce levels to normal, and recommendations to modify lifestyle and diet.Cholesterol is a fat like substance which is produced in the liver and also taken in through a person’s diet. Cholesterol travels through the body in tiny clumps known as lipoproteins. There are two types of lipoproteins: low- density lipoproteins (LDL, known as bad cholesterol) and high- density lipoproteins (HDL, known as good cholesterol). LDL’s function is to carry cholesterol where it is needed, whereas HDL’s function is to carry all left over cholesterol back to the liver. When cholesterol levels are high, cholesterol builds up in the arteries and makes the walls of the artery hard and narrow, which raises blood pressure and impedes blood flow, which in turn may cause a heart attack or stroke. This is where the function of the HDL comes into play. HDL is responsible for carting this substance away from the arteries and relieving the tension or pressure placed on that artery. For this reason, it is healthiest to have low LDL cholesterol levels and high HDL cholesterol levels.
Risk for heart disease due to cholesterol is dependent on several factors. One factor is diabetes. People who have diabetes are more prone to have low HDL and high triglyceride levels, which boost the risk dramatically. As a result heart disease occurs earlier and is more fatal. Another factor are the cholesterol levels themselves. Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides are all measured and compared to the normal values (LDL: below 100 mg/dl, HDL: higher than 55 mg/dl in women & 45 mg/dl in men, triglycerides: below 150 mg/dl), with LDL being the target or most important. Action is usually taken if LDL cholesterol levels are 100 mg/dl or higher. The first action taken is targeted at the person’s lifestyle. Changes in lifestyle are losing weight, becoming more physically active, and improving the diet with the help of a nutritionist. If these changes do not work then a cholesterol- lowering drug will be administered.
Making changes in one’s lifestyle is probably one of the hardest things to do, but with the help of a nutritionist it can make this step just a little bit easier. Following a healthy diet is very important not only to maintain weight, but to control cholesterol levels as well. With each person being unique and requiring specific foods, an eating plan is outlined for each individual person to help improve cholesterol levels. A planned diet should include: decreased intake of saturated fats (found in meat, milk, eggs) to less than 7% of calories, decreasing cholesterol intake to less than 200 mg per day, limiting trans fats (found in shortening, packaged foods, and many brands of margarine), keeping total fat intake between 25 and 35 % of calories, eating more fiber, adding plant stanols and sterols to the diet, eating smaller more frequent meals throughout the day, and drinking small amounts of alcohol. Along with diet, comes exercise and becoming more physically active. Exercise is always good for the body as well as the heart. It has been proven to help prevent heart disease and affects cholesterol levels by increasing HDL levels and decreasing LDL and triglyceride levels. An exercise program should include a minimum of 30 minutes a day or 30-60 minutes four to six times a week. Examples of some activities are bicycling, walking, jogging, swimming, or any others which increase heart rate. Weight training is also good, 2-3 times a week for arms, shoulders, chest, back, hips, and legs.
If diet and exercise do not lower the LDL cholesterol levels drug therapy is used. The first drug to be administered is one of the “statins”. Three from this group are currently used Lipitor, Pravachol, and Zocor. Side effects of these drugs are usually mild and the most common are muscle and stomach pain. If these drugs do not work then a second- choice drug is taken (bile- acid binding resins), the most common being Prevalite, Welchol, and Colestid. Side effects for these drugs include upset stomach, constipation, and these drugs also may interfere with any other drugs that a patient might be taking.
There are several factors which contribute to heart disease high blood pressure, unhealthy diet, a family history of heart disease, an inactive lifestyle, long- term emotional stress, obesity, and smoking just to name a few. When considering these factors family history is the only factor which really can not be controlled. All others seem to be a domino effect- inactive lifestyle and unhealthy diet may lead to obesity in some cases, obesity may lead to high blood pressure and maybe even to long- term emotional stress, which eventually can lead to heart disease. Knowing this information gives us the opportunity to make a decision about whether or not we want to make changes in our lifestyle. It probably will seem to be a huge sacrifice but in the end it will lead not only to being physically healthy, but mentally as well.
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